The promise and threat of self service healthcare

Technology will help save the NHS – or at least some of the cash it needs, according to a report this week from the Reform think tank. Its Expert Patients report argues that helping people manage their own conditions using technology could help save as much as £2 billion by 2020-21, as well as increase patient satisfaction with their care.

The study is part of a cacophony around the potential for self service healthcare that would see the NHS follow suit with industries such as banking and retail, and shift much activity on to the consumer. It was echoed by NHS England’s director of strategic systems and technology Beverley Bryant, who called for wider application of customer service approaches in healthcare.

As anyone who has experienced NHS care will know, its ability to design and deliver its services around the needs of its customers is a challenge. To be blunt, the NHS is built around the needs of doctors and finance chiefs. Shifting the mindset to delivering patient-centred care, and with the necessary information and services, will take some doing. As a recent BMJ blog, Time to deliver patient-centred care, noted: “Although the global flow of information has transformed many aspects of our lives, it has bypassed chunks of the health sector…Clinicians and medical educationalists must catch up.”

One pressing issue for the NHS is the prospect of disintermediation – an ugly word that means taking out ‘unnecessary intermediaries’ (read The Future of Public Services paper on the London School of Economics website to see it discussed in more detail). Banks reduced the need for frontline staff by introducing cashpoints and telephone banking. Retailers coped with increasing demand by growing their online presence. And it is beginning to take pace in healthcare, too.

Apps such as Babylon provide ready access to ‘virtual’ primary care – no more struggling with GP appointments and anachronistic waiting rooms. Patients are helping each other through social networks such as PatientsLikeMe, a trend that Facebook is looking to exploit. Worried about your health? Dr Google is coming.

The NHS could have done all of this by now. Maybe the sight of personal health budgets being pooled together to spend on app development and online communities might encourage more activity; Treasury raids on technology funding would suggest not.

Even with rising consumer demand, and pockets of promise, we may be waiting some time before digital opportunities are seized. O’Reilly’s Radar discussed self service healthcare in 2014. It saw that health IT was a necessary ingredient, but was not enough on its own. “Internal (consumers’ personal values and motivations) and external (institutional, health policy, environmental, financial) forces must also converge to motivate people to assume greater mindfulness and expend energy on their health.”

The technology can put the doctor in your pocket. But if the doctor doesn’t want to go there, it’s not going to happen. But as the rise in agency spending shows, and calls to ex-pat GPs in Australia to come back home show, doctors are part of a global market. How soon before we offshore health services? Many businesses do this as part of customer service efforts. Clinical expertise exists across the globe – you don’t have to put it on a return flight. So why not UK healthcare? Maybe I could speak to a doctor at my convenience, and not theirs.